Rhinoplasty, or surgery to reshape the nose, is one of the most common of all plastic surgery procedures. Rhinoplasty can reduce or increase the size of your nose, change the shape of the tip or the bridge, narrow the span of the nostrils, or change the angle between your nose and your upper lip. It may also correct a birth defect or injury, or help relieve some breathing problems. If you’re considering rhinoplasty, this page will provide you with a basic understanding of the procedure – when it can help, how it is performed, and what results you can expect. You should know though that a lot depends on the individual patient’s case and the surgeon. So, please make sure you ask Dr. Makram about anything you don’t understand.

THE BEST CANDIDATES FOR RHINOPLASTY

Rhinoplasty can enhance your appearance and your self-confidence. The best candidates for rhinoplasty are people who are looking for improvement, not perfection, in the way they look. If you’re physically healthy, psychologically stable and realistic in your expectations, you may be a good candidate. Rhinoplasty can be performed to meet aesthetic goals or for reconstructive purposes – to correct birth defects or breathing problems.

Age may also be a consideration. Many surgeons prefer not to operate on teenagers until after they’ve completed their growth spurt-around 16 years for girls and 18 years for boys. It’s important to consider teenagers’ social and emotional adjustment, too, and to make sure it’s what they, and not their parents, really want.

ALL SURGERY CARRIES SOME UNCERTAINTY AND RISK

When rhinoplasty is performed by a qualified plastic surgeon, complications are infrequent and usually minor. Nevertheless, there is always a possibility of complications, including infection, nosebleed, or a reaction to the anesthesia. You can reduce your risks by closely following Dr. Makram’s instructions both before and after surgery.

After surgery, small burst blood vessels may appear as tiny red spots on the skin’s surface; these are usually minor but may be permanent. As for scarring, when rhinoplasty is performed from inside the nose, there is no visible scarring at all; when an “open” technique is used, or when the procedure calls for the narrowing of flared nostrils, the small scars on the base of the nose are usually not visible. In about one case out of ten, a second procedure may be required – for example, to correct a minor deformity. Such cases are unpredictable and happen even to patients of the most skilled surgeons. The corrective surgery is usually minor.

PLANNING YOUR SURGERY

Good communication between you and your physician is essential. In your initial consultation, Dr. Makram asks you what you would like your nose to look like, evaluates the structure of your nose and face, and discusses the possibilities with you. He will also explain the factors that can influence the procedure and the results. These factors include the structure of your nasal bones and cartilage, the shape of your face, the thickness of your skin, your age, and your expectations.

Dr. Makram will also explain the techniques and anesthesia he will be using, the type of facility where the surgery will be performed, the risks and costs involved and any options you may have. Most insurance policies do not cover purely cosmetic surgery. Make sure you tell Dr. Makram if you have had any previous nose surgery or an injury to your nose, even if it was many years ago. You should also inform Dr. Makram if you have any allergies or breathing difficulties; if you’re taking any medications, vitamins, or recreational drugs; and if you smoke. Don’t hesitate to ask your doctor any questions you may have, especially when it comes to your expectations and concerns about the results.

PREPARING FOR YOUR SURGERY

Dr. Makram will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, taking or avoiding certain vitamins and medications, and washing your face. Carefully following these instructions will help your surgery go more smoothly. While making preparations, be sure to arrange for someone to drive you home after your surgery and help you out for a few days if needed.

WHERE YOUR SURGERY WILL BE PERFORMED

Rhinoplasty may be performed in an outpatient surgery center or a hospital. It is usually done on an outpatient basis, for cost containment and convenience. Complex procedures may require a short inpatient stay.

TYPES OF ANESTHESIA

Rhinoplasty can be performed under local or general anesthesia, depending on the extent of the procedure and on what you and Dr. Makram prefer. With local anesthesia, you are usually lightly sedated, and your nose and the surrounding area are numbed; you’ll be awake during the surgery, but relaxed and insensitive to pain. With general anesthesia, you sleep throughout the whole operation.

THE SURGERY

Rhinoplasty usually takes an hour or two, though complicated procedures may take longer. During surgery the skin of the nose is separated from its supporting framework of bone and cartilage, which is then sculpted to the desired shape. The nature of the sculpting will depend on your problem and Dr. Makram’s preferred technique. Finally, the skin is redraped over the new framework.

Many plastic surgeons perform rhinoplasty from within the nose, making their incision inside the nostrils. Others prefer an “open” procedure, especially in more complicated cases; they make a small incision across the columella, the vertical strip of tissue separating the nostrils. When the surgery is complete, a splint will be applied to help your nose maintain its new shape. Nasal packs or soft plastic splints also may be placed in your nostrils to stabilize the septum, the dividing wall between the air passages.

AFTER YOUR SURGERY

After surgery – particularly during the first twenty-four hours – your face will feel puffy, your nose may ache, and you may have a dull headache. You can control any discomfort with the pain medication prescribed by Dr. Makram. Make sure you stay in bed with your head elevated (except for going to the bathroom) for the first day. You will notice that the swelling and bruising around your eyes will increase at first, reaching a peak after two or three days. Applying cold compresses will reduce this swelling and make you feel a bit better. In any case, you will feel a lot better than you look. Most of the swelling and bruising should disappear within one to two weeks or so. Some subtle swelling – unnoticeable to anyone but you and Dr. Makram – will remain for several months.

A little bleeding is common during the first few days following surgery, and you may continue to feel some stuffiness for several weeks. Dr. Makram will probably ask you not to blow your nose for a week or so, while the tissues heal. If you have nasal packing, it will be removed after a few days and you will feel much more comfortable. By the end of one or, occasionally, two weeks, all dressings, splints, and stitches should be removed.

GETTING BACK TO NORMAL

Most rhinoplasty patients are up and about within two days and able to return to school or sedentary work a week or so following surgery. It will be several weeks, however, before you are entirely up to speed. Dr. Makram will give you more specific guidelines for gradually resuming your normal activities. They are likely to include these suggestions: avoid strenuous activity (jogging, swimming, bending and sexual relations – any activity that increases your blood pressure) for two to three weeks. Avoid hitting or rubbing your nose, or getting it sunburned, for eight weeks.

Be gentle when washing your face and hair or using cosmetics. You can wear contact lenses as soon as you feel like it, but glasses are another story. Once the splint is off, they will have to be taped to your forehead or propped on your cheeks for another three months. Dr. Makram will schedule frequent follow-up visits in the months after surgery to check on the progress of your healing. If you have any unusual symptoms between visits, or any questions about what you can and can’t do, don’t hesitate to call your doctor.

YOUR NEW LOOK

In the days following surgery, when your face is bruised and swollen, it’s easy to forget that you will be looking better. In fact, many patients feel depressed for a while after plastic surgery – it’s quite normal and understandable. Rest assured that this stage will pass. Day by day, your nose will begin to look better and your spirits will improve. Within a week or two, you will no longer look as if you’ve just had surgery.

Still, healing is a slow and gradual process. Some subtle swelling may be present for months, especially in the tip. The final results of rhinoplasty may not be apparent for a year or more. In the meantime, you might experience some unexpected reactions from family and friends. They may say they don’t see a major difference in your nose. Or they may act resentful, especially if you’ve changed something they view as a family or ethnic trait. If that happens, try to keep in mind why you decided to have this surgery in the first place. If you’ve met your goals, then your surgery is a success.